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LIBRARY OF CONGRESS, 

i 

AMERICA. 



URINALYSIS, 

A GUIDE 

FOR THE BUSY PRACTITIONER 

HEINRICH STERN, Ph.D., M.D. 




'•»■• *>-» igj| « 






0- 



x 



m 



E. R. PELTON, 

:2g Fifth Avenue, New York. 
1897. 






I OPYRIGH i Bl v. k. PBLTOM 



The purport of this little book — thoroughly 
practical and concise in its scope — is to aid 
the busy practitioner in his routine work. 
For theoretical and protracted explanations 
the physician must naturally resort to the 
more exhaustive treatises upon the same sub- 
ject. 

H. S. 

New York, April, 1897. 



I. 
The Physician's Laboratory. 

A medium-sized table and a few shelvings 
answer well for a physician's laboratory. The 
table should be covered, if possible, with a 
plate of stout glass. 

Apparatus necessary for urinalysis : 

One alcohol lamp, or one Bunsen burner, 
with rubber tubing. 

Twelve test tubes, assorted sizes. 

One test tube holder. 

One test tube rack. 

One test tube brush. 

One 2 oz. graduate. 

One porcelain evaporating dish. 

Two glass funnels, with holders. 

One glass stirring rod. 

Six glass evaporating dishes, or watch crys- 
tals. 

Two pipettes. 

One Mohr's burette. 

Four beaker glasses. 

One pair pincers. 

One pack white filter paper. 

One sheet platinum foil, Y\ in. square. 

Two screw-capped vials, containing blue 
and red litmus paper respectively. 

One urinometer. 

One albumenometer. 

One ureometer. 

One saccharometer. 

One microscope, and accessories. 

For reagents and formulae of test solutions, 
see Part II. 



GENERAL CHARACTERISTICS OF NORMAL URINE. 

Introduction, 



Clinical medicine of the day has profited 
greatly by the advancement of physiological 
chemistry and by the general and rational 
use of the microscope. The exact determina- 
tion of the composition of urine especially 
furnished us many a clue as to the physio- 
logical processes within the organism, and 
has made us understand the true nature of a 
variety of pathological changes, which, but a 
short time since, were neither definitely de- 
scribed nor, in most instances, at all recog- 
nized. Urinalysis has become an important 
factor in investigating and determining dis- 
ease, and although not all bodily afflictions 
can be diagnosticated directly by the urine, 
there is no serious ailment which in some 
way or other does not cause changes in the 
condition of the urine. 



General Characteristics of Normal Urine. 

Quantity of Urine. — The quantity of urine 
passed by a healthy individual, in twenty-four 
hours, varies greatly, and is always dependent 
upon the amount of food and fluids taken into 
the system and upon the activity of the lungs 
and the skin. The average amount of urine 
voided for an adult is estimated at from 1,200 
to 1,500 cubic centimetres (40-50 fl. oz.) per 
diem. 



GENERAL CHARACTERISTICS OF NORMAL URINE. Q 

Color. — When freshly voided, the urine of a 
healthy person is a clear, straw-colored fluid, 
but as it is in most instances dependent upon 
the degree of its concentration, it may present 
all shades of color, from a watery appearance 
to a deep brown. 

Odor. — Normal, freshly voided urine has a 
peculiar aromatic (urinous) odor, which may 
be due to the presence in minute quantities 
of damolic, damoluric, phenylic and taurylic 
acids. Upon standing, the urine decomposes 
and acquires a putrid odor, in which ammonia 
is especially conspicuous. 

Consistency. — Normal urine is always 
aqueous, and flows like water. 

Reaction. — Normal, fresh urine is gener- 
ally more or less acid. This is due to acid 
sodium phosphate, and not to free acids. 
The degree of acidity of urine varies at differ- 
ent hours of the day. After meals the pro- 
nounced acidity decreases, but it is never 
perfectly neutral. Occasionally, when voided 
during the process of digestion, the urine is 
perceptibly alkaline. 

After standing for some time at an ordinary 
temperature, the urea present is decomposed 
into ammonium carbonate, thus rendering the 
urine conspicuously ammoniacal in odor as 
well as in reaction. 

Specific Gravity. — The density of normal 



GENERAL CHARACTERISTICS OF NORMAL URINE. IO 

urine varies greatly — it averages between 
1,015 an d 1,025. Variations therefrom are 
consistent with perfect health, and depend 
largely upon the character and quantity of 
the food taken. 

Urinometers are instruments for determin- 
ing the density of urine. They are small 
hydrometers, gradu- 
ated from 1. 000 to 
1.060, to read specific 
gravity directly, but 
are often inaccurate. 
Dr. Squibb's urinom- 
eter is probably the 
best. 

Transparency.— 
Normal, freshly voided 
urine is always clear, 
although never per- 
f e c 1 1 y transparent ; 
upon standing, a slight FlG - r - 
mucus cloud can be 
noticed, which remains unchanged when sub- 
jected to heat, alkalies or mineral acids. 

Solid Matter. — Normal urine contains, 
when voided in quantities from 1.200 to 1.500 
c.c, about 4-6% of solid matter, of which more 
than half is organic. 

A quick, and for all practical purposes suf- 
ficient, method to determine the solids of the 
urine, is the following one : Multiply the last 




I 



-Squibb's Urinom- 

ETER. 



CHEMICAL ANALYSIS. II 

two figures of the specific gravity of the urine 

by the co-efficient of Haser, which is 2.33. 

This indicates, in an approximate way, the 

amount of grammes of solid matter in each 

1. 000 c. c. of the urine, as for example : The 

amount of urine voided in 24 hours being 

1.600 c. c, the specific gravity 1.015, with 

Haser's co-efficient we have 

r 5 X 2.33 = 34.95 grammes in i.ooo c. c. of urine; 

^ r 34-95 X 1.600 , 

therefore — — = SS-9 2 grammes of 

1.000 DD y s 

solids. 



II. 

Chemical Analysis. 

a. Normal Constituents of Urine. 



The urine contains about 95$ of water ; its 
composition is very complex ; it contains 
Urea, (NH 2 ) 2 CO, ^ 

Uric acid, C 6 H 4 N 4 3 , 
Kreatinin, C 4 H 7 N 3 O, 
Kreatin, C 4 H 9 N 3 2 , 
Xanthin, C 5 H 4 N 4 O,, 
Mucin, 

Hippuric acid, C 9 H 9 NO, 
Oxalic acid, C 2 H 2 4 , 
Urabilin, \ 

Urochrom, \ Coloring matter. 
Indican, ) 



Organic matter. 



NORMAL CONSTITUENTS OF URINE. 

Sulphuric acid, H 2 S0 4 , \ 

Phosphoric acid, H 3 P0 4 , 

Chlorine, 

Potassium, \ Inorganic 

Sodium, stituents. 

Calcium, 

Magnesium, 

Iron, 

Carbon Dioxide, ) 

Nitrogen, V Gases. 

Oxygen, ) 

Detection and Determination of the Normal Con- 
stituents of Urine. 
Urea. — Normal quantity in the urine, about 

Detection : 

By hypobromite of sodium. 

Add to the urine in a test tube an equal 
quantity of hypobromite of sodium solution. 
If urea be present, bubbles appear rapidly. 
Determination : 

By hypobromite method. 
(Preparation of Knop's test fluid : 
250 c. c. distilled water. 
+ 100 grms. caustic soda. 
+ (after cooling) 25 c. c. bromine. 
The solution does not keep well ; it is 
therefore advisable to prepare it always fresh, 
thus : 10 c. c. sodium hydroxid sol. 
+ ice. bromine (sol. 1 to 10). 



NORMAL CONSTITUENTS OF URINE. 13 

After alkali and bromine are completely 
mixed, add equal volume of water.) 

The ureometer is devised to carry out this 
method. The most simple and practical in- 
strument is Dr. Doremus's. 

Fill the bulb of the appa- 
ratus with the testing solu- 
tion ; incline instrument so 
that the long arm is filled to 
the bend at the bulb. Take 
1 c. c. of urine to be exam- 
ined with the pipette and 
drop it slowly into the solu- 
tion in the long arm. Rapid 
decomposition of urine oc- 
curs ; nitrogen bubbles rise 
in the long arm of the tube ; 
the liquid flows back into the 
bulb. In 15 minutes 
the urea is completely 
decomposed. The 
graduation indicates 
the quantity of urea 
in the volume of urine 
examined. If you 
wish to know per- 
centage of urea in- 
stead of grammes per 
c. c, remove decimal 
point two figures to 



— *, 

— * 

- * 

- w 

UOI 



— ft02 



— eo3 




Fig 



the right, for instance 



NORMAL CONSTITUENTS OF URINE. 14 

0.02 gramme to the c. c is 2$ of urea ; 0.015 
gramme is 1.5$. 

Uric Acid. — Normal quantity excreted per 
diem about 0.5 gramme (8 grains). 

Detection : 
By murexide test. Reagents : Cone, nitric acid and 
diluted ammonia. 

Place some urine in an evaporating dish ; 
evaporate to dryness. Add to the residue 
1 or 2 drops of concentrated nitric acid. 
Evaporate again to dryness. Add 1 or 2 
drops of diluted ammonia. Notice the 
striking purple-red color, which turns violet 
when potash is added. 

Kreatinin. — Normal quantity excreted per 
diem from 0.75 to 1 gramme (10-16 
grains). 

Detection : 

By 
Reagents : Nitric acid and phospho-molybdic acid. 

Place some urine into a test tube ; add a 
few drops of nitric acid ; heat gently and 
add some phospho-molybdic acid. Notice 
the yellow crystalline precipitate, which 
dissolves in hot nitric acid. 

Xanthin. — Occurs in exceedingly minute 
quantities ; analysis not practicable. 

(Neubauer found 1 gramme in 300 
litres of normal urine.) 




NORMAL CONSTITUENTS OF URINE. I 5 

Mucin. — Always present in very small quan- 
tities. 

Detection : 
By 

Reagents : Acetic acid and liquor iodi comp. 

Add to the urine in a test tube a few 
drops of acetic acid and a few drops of 
liquor iodi comp. Notice threads and 
bands of mucin. If nitric acid is added 
these are dissolved again. 

Hippuric Acid. — Normal quantity excreted 
per diem about 0.75 gramme (10 grains). 

Detection : 

Reagent : Nitric acid. 

Evaporate urine with nitric acid, heat 
residue in dry test tube. If hippuric acid 
be present, an odor like that of bitter 
almonds is perceivable, due to the de- 
velopment of nitrobenzol. 

Oxalic Acid. — Never occurs in the urine in a 
free state, always as oxalate of lime. 
Amount excreted per diem about 0.1 
gramme (i}4 grains). 

Detection : 

As oxalate of lime crystals by microscope. 

Sulphates. — Quantity excreted per diem 
about 2 grammes (30 grains). 



NORMAL CONSTITUENTS OF URINE. IO 

Detection : 

By acidulated barium chloride solution. 

Formula of Reagent : 
Acid hydrochloric, i part. 

Baric chloride, 4 parts. 

Distilled water, 16 parts. 

Add to 10 c. c. of urine, in a test tube, 
3 c. c. of the reagent. Notice the immedi- 
ate appearance of a white, milky precipi- 
tate, indicating the presence of sulphates. 

Phosphates. — Earthy Phosphates excreted 
per diem about 1 to 1.5 grammes (16-24 

grs.) 

Alkaline Phosphates excreted per 
diem about 2 to 4 grammes (32-64 grs.) 
Detection : 

Of earthy phosphates. 
Make the urine alkaline with ammonium, 
sodium or potassium, and heat. Notice 
whitish cloud, which soon precipitates 
white or gray. The latter is dissolved when 
acetic acid is added. 

Of alkaline phosphates. 
By magnesium fluid. 

Preparation of Reagent : 
Liquor ammonium, - - - 1 part. 

Ammonium chloride, - - - 1 part. 
Magnesium sulphate, - - - 1 part. 
Distilled water, 8 parts. 

Filter off the precipitated earthy phos- 
phates, and add to the filtrated urine one- 
third its volume of the reagent. Notice 



ABNORMAL CONSTITUENTS OF URINE. 1 7 

snowy deposit — precipitated alkaline phos- 
phates. 

{ Chloride of sodium (common 

., , -^ salt). 

Chlorides. — ^ lt u ' . 

potassium. 



ammonium. 
Quantity excreted per diem 15 grammes ( 3 hs). 
Detection and Approximate Determina- 
tion : 
By nitrate of silver solution (strength 1 to 8). 

Acidify half a test tube full of urine with 
a few drops of nitric acid, then add 1 or 2 
drops of the nitrate of silver solution. 
Note changes ! If rather heavy, either curdy 
or lumpy, quickly sinking precipitate, — chlo- 
rides are present in the average quantity, 
about 0.75$. 

If urine only becomes cloudy or milky, 
chlorides present are diminished to about 
0.1$. 

If urine remains unaffected, no chlorides 
are present. 



b. The Principal Abn or 7?ial Constituents of Urine. 



Serum albumin, 

Serum globulin, haemoglobin, 

_> , .« /Albuminates, 

Proteids. — < _, ' , 

Proteoses or albumoses, 

Peptones, 

Mucin. 



ABNORMAL CONSTITUENTS OF URINE. lb 

Dextrose (glucose, grape sugar), C G H 12 O , 

Acetone, C 3 H (i O, 

Pus, 

Bile acids, 

Bile pigments. 

Detection and Determination of Abnormal Con- 
stituents of Urine. 

While for all practical purposes one single 
test is sufficient to detect or to determine a 
normal constituent of urine, two or more tests 
should invariably be applied for the detection 
or determination of a suspected abnormal con- 
stituent. 

Until recently the proteids occurring in the 
urine were all classed together as "albumin." 
There are, at least, six proteid substances 
which may appear in urine — each of a different 
significance. The one proteid body interest- 
ing us mostly is serum albumin. As tests i, 2 
and 3 are apt to precipitate other proteids than 
serum albumin, I recommend tests 4, 5 and 6 
as trustworthy in detecting serum albumin. 
Serum Albumin. — Occurs in urine, mostly to- 
gether with paraglobulin, and in very 
minute quantities, rarely over 1-2$ by 
actual weight. 

Its presence may depend upon : 

1. Pathological conditions of the kidney. 

2. Excess of albumin in the blood, and 

changes of the latter's constitution. 

3. Disturbances of circulation. 



ABNORMAL CONSTITUENTS OF URINE. 19 

In many cases albumin is not constantly- 
present ; the quantity differs often. The 
urine may be free from albumin just after 
rising, when an hour or two later, especially 
after walking or manual labor, it will be pres- 
ent again. 

The occurrence of albumin in the urine, 
although per se an abnormal condition, does 
not indicate renal changes, unless accom- 
panied by such pathological products in the 
urine as casts, epithelium, etc., which are the 
result of kidney disease. 

Detection : 

1. By heat and acetic acid. 

Fill a test tube ^ full of urine. If alka- 
line, add a few drops of acetic acid. If 
urine be acid, do not add anything. Boil 
upper part of urine and examine carefully 
while holding it against a dark background. 
If urine, where it was heated, looks turbid, 
let it cool for a few minutes, and add after- 
wards a few drops of diluted nitric acid. 
If turbidity remains or is increased, albu- 
min is present. 

2. By heat and nitric acid. 

Place about 8 grammes of urine (2 
drachms) into a test tube and boil. If pre- 
cipitate occurs it consists either of earthy 
phosphates or albumin. To. differentiate, 
add a few drops of nitric acid. If precipi- 
tate disappears, it is due to the presence of 



ABNORMAL CONSTITUENTS OF URINE. 20 

earthy phosphates ; if it remains, it is caused 
by albumin. 

3. By nitric acid test (Heller's). 

Place about an inch of pure nitric acid 
into a test tube, and drop the urine to the 
same amount gently along the inside of the 
tube while you hold this in an inclined posi- 
tion. This is absolutely necessary, as the 
urine must lay on top of the acid, and must 
not mix with it. Notice opalescent zone at 
the point of contact if albumin be present. 
If only small traces of albumin are present, 
the ring of coagulated albumin will appear 
about half an hour later. Therefore, set 
the tube always aside, if no ring is formed, 
and re-examine later. 

When this test is applied a brownish 
turbidity may appear, which may be taken 
for albumin. This is caused by precipita- 
tion of urates, and never appears at the point 
of contact betiveen the acid and the urine, but in 
the urine itself. When heated a little the 
precipitated urates disappear again. 

If mucin be present in excess, a light tur- 
bidity may appear near the surface of the 
urine, when this test is applied. 

4. By Purdy's test. 

Reagents : Solution of chloride of sodium, saturated 

and filtered, and acetic acid. 

Raise first specific gravity of urine about 
10 to 15 degrees by the addition of sodium- 



ABNORMAL CONSTITUENTS OF URINE. 21 

chloride solution. Fill test tube two-thirds 
with this urine, add 1-2 drops of strong 
acetic acid, and boil upper part of urine for 
about half a minute. Examine in good 
light, and if albumin be present it will ap- 
pear in the upper boiled portion of the 
urine as a milk-like turbidity, more or less 
pronounced according to the amount of 
albumin present, while the lower, unboiled 
portion remains perfectly clear. This test 
avoids the mucin reaction. 

5. By ferrocyanide test. 

Reagents : Solution of potassium ferrocyanide 1 to 20 ; 

and acetic acid. 

Fill test tube half full of urine, add 1 
drachm (4 grammes) of potass, ferrocyanide 
solution. Shake well and add 10 to 15 drops 
of acetic acid. If albumin be present it will 
be precipitated throughout the urine as a 
milk-like flocculency — more or less pro- 
nounced according to amount of albumin 
present. Never add acetic acid before the alka- 
line potass, ferrocyanide solution is mingled 
with the urine, on account of precipitation of 
mucous. This test is a most trustworthy one. 

6. By Tanret's reagent, the potassio-mercuric-iodide 
test. Modification by Elliott, of Chicago. 
Preparation of Reagent : 
Iodide of potassium, - - 3.32 grammes. 
Bichloride of mercury, - 1.35 grammes. 
Acetic acid, - - - - 20 c. c. 
Distilled water, - - - 64 c. c. 



ABNORMAL CONSTITUENTS OF URINE. 22 

(Dissolve iodide of potass, and bichlor. of 
mere, separately in water, and mix the solu- 
tions. Then add the acetic acid, and 
filter.) 

Fill test tube half full of urine, add 5 to 
10 drops of acetic acid and 4 grammes ( 3 i) 
of the reagent. If albumin be present, 
even in the smallest amount, a precipitate 
will occur. If there be no reaction, it may 
be concluded that the urine is free from all 
proteid substances, and all further tests for 
them may safely be abandoned. 

If precipitate occurs, heat ; if caused by 
peptones or proteoses, it will disappear or 
will diminish ; if caused by serum albumin 
or by mucin, it will remain unaltered or 
will be intensified. 

If precipitate persists after heating, sub- 
mit fresh urine to the ferrocyanide of potas- 
sium test (No. 5). If positive reaction fol- 
lows, serum albumin is present. Negative 
result shows the substance present to be 
mucin. 

If heating causes disappearance of origi- 
nal precipitate, indication is that either pep- 
tones or proteoses are present. Apply again 
potassio-mercuric-iodide test to some fresh 
urine, and shake precipitate with ether. If 
due to peptones or proteoses it is not dis- 
solved. Differentiate between these two by 
sulphate of ammonium test. 



ABNORMAL CONSTITUENTS OF URINE. 

Determination : 



23 



TW 



Fig. 3. 

Esbach's 

Albuminom- 

ETER. 



By Esbach's method. 
Reagent : 
Picric acid, - 10 grammes. 
Citric acid, - 20 " 

Distilled water, q. s. 1000 c. c. 

This test is made with the albu- 
minometer, a standard graduated 
glass tube. 

Fill albuminometer with urine 
to letter U., add reagent to R., 
close tube with stopper and shake 
until urine and reagent are thor- 
oughly mixed. Put the tube aside 
for 24 hours, and then read off 
number of grammes of albumin 
to the litre (1000 c. a), which will 
be indicated by number on side 
of the albuminometer on a level 
where albumin settles. If, instead 
of number of grammes of albumin 
per 1000 c. c, percentage of albumin 
be desired to be known, remove 
decimal point one figure . to the 
left ; for instance, 3 grammes per 
litre would be 0.3$ of albumin. 
Esbach's albuminometer is gradu- 
ated to 7 grammes per litre, 0.7$ 
of albumin. If urine be very rich 
in albumin, it should be diluted 
with one or two volumes of water 



ABNORMAL CONSTITUENTS OF URINE. 24 

before testing, and result multiplied by 2 
or 3, according to degree of dilution. 

Globulin. — Is nearly always associated with 
albumin in the urine. 

Detection : 

Fill a test tube with water and drop into 
it some large drops of urine. If globulin 
be present, each falling drop is followed by 
a milky streak, which, when 15 or 20 drops 
have fallen, give the water a slight milky 
appearance. The addition of acetic acid 
clears the water again. 

Haemoglobin. — 

Detection : 

Fill test tube one-half of urine and boil. 
If haemoglobin be present, a mottled pre- 
cipitate of albumin and haematin will ap- 
pear. Add caustic potash to the boiling 
urine. Note resulting clearness of urine, 
which turns green when examined in thin 
layers. 

Peptones. — Occur often in combination with 
albumoses, and closely resemble each 
other. 

Halliburton differentiates between 
the two : 



Pep ton. 
No precipitate with 
nitric acid. 



ABNORMAL CONSTITUENTS OF URINE. 25 

Deutero-albumose. 
Noprecip.with H N 3 , 
unless considerable 
amount of Na CI be 
added. This precip. 
disappears on heat- 
ing and reappears 
on cooling. 

2. Is not precipitated Is precipitated by satu- 
by saturation with ration with ammo- 
ammonium sul- nium sulphate, 
phate. 

Detection : 

By ammonium sulphate. 
Saturate slightly acidified urine with am- 
monium sulphate, and filter out any pre- 
cipitate, which may consist of albumin, 
globulin and albumose. Proteid remaining 
may be precipitated by potassio-mercuric- 
iodide, and can only be the peptone. 

Mucin. — Occurs in normal and abnormal 
urines. It is considered abnormal when 
found in unusual large quantities. 

(See under "Normal Constituents," page 15.) 

Dextrose (glucose, grape sugar). — Occurs in 
urine as a result of temporary condi- 
tions, and is persistently present in 
diabetes mellitus. 
Urine which is light in color, of a spe- 




ABNORMAL CONSTITUENTS OF URINE. 26 

cific gravity above 1028, should always 
be tested for dextrose. 
Detection : 

1. By bismuth test (Boettger's). 
Reagents : Liquor potassae and basic nitrate of bis- 
muth. 
Remove albumin before applying this test ! 

Place 5 c. c. of urine into a test tube and 
add the same amount of liq. potass., and 
also a little nitrate of bismuth. Boil gently. 
Note, if glucose be present, gray or black 
color of precipitate. The darker the color 
the greater the amount of sugar present. 

2. By Fehling's solution. 
Formula of Reagent : 
Crystallized cupric sulphate, 34,639 grammes. 
Sol. of sodium hydroxid, - 500 c. c. 
Neutral sodium tartrate, - - 173 grammes. 

(Dissolve sulphate of copper in 100 c. c. 
of distilled water ; then dissolve neutral 
sodium tartrate in sodium hydroxid solu- 
tion, and add slowly and in intervals the 
copper solution, and bring finally the vol- 
ume of the whole up to 1000 c. c. with 
distilled water. 

The solution decomposes readily. It is 
best to have it always prepared freshly in 
just the quantity needed. The pellet form, 
devised by Pavy, in which the salts for the 
solution are kept separately, does not re- 
tard decomposition either. 



ABNORMAL CONSTITUENTS OF URINE. 27 

If testing with Fehling's solution or with 
any other copper test, do ?iot boil urine longer 
than for about half a minute)) 

Fill test tube with about 5 c. c. of the test 
solution and boil. If test solution remains 
clear blue, add 3 or 4 drops of urine to be 
examined, and keep boiling. Note, if much 
sugar be present, after a short time, dense 
yellow color, and later a yellowish-red sedi- 
ment falling to the bottom of the tube. 

If no reaction occurs continue adding urine 
to test solution, but the urine's volume must 
never exceed that of the test fluid. 

3. By Haines's test. 
Formula of Reagent : 
Copper sulphate, - - 30 grains (2 grms). 
Distilled water, - - § hs. (15 grms). 

Make a perfect solution and add 
Pure glycerin, - - § hs. (15 grms.) 

Mix thoroughly and add 
Liquor potass., - - 1 v. (150 grms.) 

Solution remains stable and is always 
trustworthy for testing. 

Fill 5 c. c. of the test fluid into a tube and 
boil gently. Then add from 6 to 8 drops — 
never more — of the suspected urine, and boil 
again. If sugar be present a yellow or 
yellowish-red precipitate is thrown down. 
If no such precipitate occurs sugar is ab- 
sent. 



ABNORMAL CONSTITUENTS OF URINE. 28 

4. By phenil-hydrazin test. 
Reagents: Phenil-hydrazin hydrochloride, sodium ace- 
tate and distilled water. 
(Caution. — Be careful in handling phenil-hydrazin 
hydrochloride as it may produce, if brought in contact 
with the skin, a nasty eczema.) 

Add to 25 c. c. of urine i gramme of 
phenil-hydrazin hydrochloride, 0.75 gramme 
of sodium acetate and 10 c. c. of distilled 
water. Place the whole in a water-bath 
after having it put into a suitable vessel, 
and warm it for about one hour. Remove 
then the vessel and allow it to cool ; if sugar 




Fig. 4. — Crystals of Phenylglucosazone. 
(After von Iaksch.) 



ABNORMAL CONSTITUENTS OF URINE. 29 

be present — if even only in traces — a yel- 
lowish precipitate will form, which may ap- 
pear amorphous macroscopically, but which 
when examined microscopically will be seen 
to contain fine bright-yellow, needle-like 
crystals, either single or arranged in stars, — 
phenylglucosazone. 

This test is very trustworthy and can be 
highly recommended, as it gives no reaction 
with any other substances of the urine than 
grape sugar. 

Determination : 

i. By fermentation. 

Take two specimens of about ioo grammes 
each from the 24 hours urine and add to 
one a little German yeast. Perforate stop- 
per of bottle where yeast is contained, and 
keep the other bottle tightly corked. Set 
both bottles in a warm place — about 70 to 
8o° Fahrenheit— and allow to ferment. In 
about 24 hours fermentation of sugar is 
completed. Next take specific gravity of 
both specimens. The degrees of density 
lost indicate the number of grains of sugar 
in each fluid ounce of the tested urine. For 
instance, if specific gravity of urine be 
1.045 before fermentation and [.020 after 
fermentation, 25 grains of sugar were con- 
tained in the urine. 

To determine amount of sugar in per 
cents., approximately, multiply number of 



ABNORMAL CONSTITUENTS OF URINE. 30 

lost degrees by o.2j. If metric system is 
used, each degree of specific gravity lost 
will correspond to .2196 grammes of sugar 
in every 100 c. c. of urine. 

2. By Fehling's solution. 

Place 10 c. c. of the solution into a por- 
celain capsule and dilute with 40 c. c. of 
water. Dilute urine with nine times its vol- 
ume of water, and fill a Mohr's burette 
with the same. Slowly bring diluted solu- 
tion to boiling point and add the urine 
from the burette in small portions to the 
boiling solution until the blue color has 
completely disappeared. Gently boil after 
each addition from the burette and let the 
mixture stand for a few seconds, after 
which examine carefully if it contains any 
blue color. 

When blue color has disappeared entirely, 
read off from the burette the quantity of 
diluted urine employed for the test, and as 
it takes just 0.05 gramme of grape sugar to 
remove blue color in the 10 c. c. of Fehling's 
solution, the percentage of the sugar may 
be readily determined. 

3. By Whitney's reagent. 
Formula of Reagent (parts by weight): 

GRAMMES. 

Ammonii sulphatis (C. P.), - - 1-2738 

Cupri sulphatis (C. P.), - 2.5587 

Potassii hydroxid (C. P.), - - - 19.1620 

Aquae ammon. (sp. gr. 8.80), - - 312.2222 

Glycerini (C. P.), .... 60. 

Aquae (dest.), q. s. 



ABNORMAL CONSTITUENTS OF URINE. 3 1 

Accuracy, stability, simplicity, reliability 
and perfect end reaction are claimed for 
this reagent. The Lewis Chemical Com- 
pany, No. 1300 Broadway, New York City, 
keeps this reagent, accurately compounded, 
in stock. In order to save trouble and 
annoyance in preparing it, it would be best 
to procure the reagent from that firm. 

For practical testing with Whitney's re- 
agent ten minims of urine only are used. 

Heat 4 grammes ( 3 i) of the reagent in a 
test tube to boiling ; add urine slowly, drop 
by drop, until the blue color begins to fade; 
then more slowly, boiling three to five 
seconds after each drop, until the reagent 
he perfectly colorless, like water, or until ten 
drops only are added. 

Dr. Whitney has prepared the following 
table : 



If reduced by 


It contains to the Ounce 


Percentage 


i minim 


16. grains or more 


3-33 


2 minims 


8. 




1.67 


3 


* 


5-33 ' 




1. 11 


4 


< 


4- 




0.83 


5 


' 


3.20 ' 




0.67 


6 


' 


2.67 ' 




0.56 


i 


' 


2.29 ' 




0.48 


8 


t 


2. ' 




0.42 


9 


' 


1.78 ' 




o.37 


10 


' 


1.60 ' 




o.33 



Reagent, after reduction, will turn blue 
again on cooling. This should not be as- 



ABNORMAL CONSTITUENTS OF URINE. 32 

cribed to imperfect reduction or defect in 
the reagent. 

If urine contains a large amount of 
albumin, reduction proceeds as usual, but 
reagent presents a yellowish tint, more or 
less pronounced according to amount of 
albumin. If urine contains too much sugar, 
dilute with one to ten volumes of water. 

Acetone. — A product of albumin decompo- 
sition ; occurs in the course of a variety 
of pathological conditions, especially in 
the advanced stages of diabetes mel- 
litus. 

Detection : 

1. By Chautard's test. 
Reagent : Aqueous sol. of magenta decolorized by- 
sulphurous acid. 

To 5 c. c. of urine add one drop of the 
reagent. If acetone be present in quantities 
over 0.01 per cent., a violet color will appear 
in five minutes. 

2. By Lieben's test. 
Reagents : Potassium iodide and liquor potassse. 

Distill small quantity of urine, if possible. 
Take into a test tube 4 c. c. ( 3 i) of liq. 
potassi, add 1.35 grammes (20 grains) of 
potassium iodide and boil ; next float the 
urine (a distillate if possible) upon the test 
solution. Note at the point of contact 
precipitation of phosphates, which becomes 



ABNORMAL CONSTITUENTS OF URINE. 



33 



yellow and filled with molecules of iodoform 
if acetone be present. 

Pus. — Occurs in urine as the result of inflam- 
mation and lesion in some part of the 
urinary tract. On account of its tur- 
bidity and sediment, urine containing 
pus often resembles urine rich in gran- 
ular urates, and its deposit often closely 
resembles that due to earthy phos- 
phates. Heat clears urine containing 
urates, while it increases turbidity of 
pus containing urine ; addition of an 
acid dissolves phosphates, while turbid- 
ity of pus containing urine is increased. 

Detection : 

By Donnes's test. 
Let sediment settle, pour off supernatant 
urine, and add liquor potassse. If sediment 
be pus, it is immediately converted into a 
substance of gelatinous-like consistency, 
which sticks to the glass, and pours like a 
heavy syrup. 

Bile Acids. — Occur in urine in a variety of 
pathological conditions, especially in 
malaria and hepatic congestion. They 
are very toxic. 
Detection : 

By Pettenkofer's test. 
Reagents : Concentrated sulphuric acid and cane 
sugar. 



ABNORMAL CONSTITUENTS OF URINE. 34 

Take some urine into a porcelain capsule, 
add some cane sugar, and dissolve the latter ; 
then add slowly, drop by drop, concentrated 
sulphuric acid, and stir continually with a 
glass rod, taking care all the time that the 
temperature does not rise above 70 Celsius. 
The solution turns to a cherry red and then 
changes to purple afterwards, if bile acids 
be present. 

As albuminous substances (when subjected 
to the same treatment) give the same color, 
in order to make this test for the bile acids 
a trustworthy one, spectroscopical examina- 
tion for the two characteristic bands should 
be made, if possible. 

Bile Pigments. — Occur in urine in jaundice, 
phosphorous poisoning, and a number 
of pathological conditions of the liver. 
The urine under such circumstances is 
always of a brownish or greenish hue. 

Detection : 

1. By Ultzmann's test. 

Reagents : Satur. caustic potash sol. and hydro- 
chloric acid. 

Place 10 c. c. of the urine into a test tube, 
add 3 c. c. of satur. caustic potash sol., and 
acidify with hydrochloric acid. Note beau- 
tiful green color of urine if bile pigments 
be present. 




MICROSCOPICAL EXAMINATION. 35 

2. By Gmelin's test. 
Reagent : Nitric acid and nitrous acid of commerce 
(HN0 3 + NO,). 
Place a few drops of urine on a white 
porcelain capsule and allow a drop of nitric 
acid, yellow with nitrous acid fumes, to run 
into it. Note, if bile pigments be present, 
appearance of rainbow-like play of colors — 
green, blue, violet, red and yellow. 

The same test may be applied as follows : 
Place some concentrated nitric acid, con- 
taining a little yellow nitrous acid, into a 
test tube, and add thereto some urine, while 
you hold the tube in an inclined position. 
If bile pigments be present there will appear 
in the zone between the fluids from below 
upward the colors green, blue, violet, red 
and yellow. 



III. 

Microscopical Examination, 

The microscope 1 is a very valuable adjuvant 
in urinalysis, and this can never be called 
complete unless the sediments of the urine 
have been subjected to a rigid microscopical 
examination. 

The sediment is usually obtained by allow- 

1 The necessary technique and practical knowledge for micro- 
scopical work may be acquired best by practical instruction. A 
few lessons from one experienced with the work will generally 
suffice. 



SEDIMENTS IN ACID URINE. 36 

ing the urine to settle for a number of hours — 
from 18 to 24 — in a conical glass, at the bottom 
of which it generally collects. 

The more modern method of obtaining 
urinary sediments is by means of the centrifu- 
gal separator. Its advantages over the old 
method are principally — permittance of an im- 
mediate microscopical examination ; examination 
may be made of freshly voided urine before any 
cha?iges occur in it. 

Urinary sediments may be divided into two 
classes, viz., chemical bodies and anatomical 
bodies. 

a. Chemical Bodies. 
The chemical bodies as found in urinary 
sediments may be subdivided again into : 
t. Sediments in acid urine : — 

Uric acid, urates, calcium oxalate, cal- 
cium sulphate, hippuric acid, and into : 
2. Sediments in alkaline urine : — 

Triple phosphates, calcium phosphate, 
ammonium urate, calcium carbonate, 
leucin and tyrosin, and cystin. 

1. Sediments in Acid Urine. 
Uric Acid. — Occurs mostly as a reddish sedi- 
ment, and is readily perceptible by the 
naked eye. The crystals are usually 
quite large, and often concrete together, 
appearing like red sand or gravel at the 
bottom or along the sides of the vessel 



SEDIMENTS IN ACID URINE. 37 

containing the urine ; they differ from 
all other urinary sediments in their 
color ; they may appear occasionally 
pale yellow, but they are never color- 
less. 
Under the microscope the crystals present 
various forms, viz.: 

Rhombic prisms, cubes, quadrangular 
plates, circles, long pointed crystals, which 
are often united at one end, thus forming 
beautiful figures, as stars, rosettes, etc. 




Fig. 5. — Uric Acid Crystals. 

Uric acid crystals are of clinical and patho- 
logical importance when deposit occurs 
soon after the urine is voided. Normal urine 



SEDIMENTS IN ACID URINE. 38 

generally precipitates its uric acid crystals 
after standing ten or more hours. If uric 
acid be thrown down soon after cooling of 
urine, it may be concluded that the same is 
liable to happen before it is voided, thus 
causing formation of gravel and calculi. 

The great majority of stones is entirely or 
chiefly composed of uric acid — from 75$ to 
90$. Uric acid calculi are quite large, very 
hard and dense. 

Acid Urates. — 

Acid Urate of Sodium forms a sediment 
which is most always granular or amor- 
phous. It ranges in color from light pink 




Fig. 6. — Acid Urate of Sodium Crystals. 



SEDIMENTS IN ACID URINE. 39 

to red-brown and may occur in a crystalline 
form, star or fan shaped. 

Acid Urate of Potassium occurs only in 
amorphous form, and is, like acid urate of 
sodium, a constituent of the mixed urate 
deposit or " brick dust." 

Acid Urate of Calcium may also occur as 
a urinary precipitate. 

With uric acid the urates (the principal 
constituent of which is the alkaline urate 
of ammoniuni) form calculi often met with 
in children ; with calcium oxalate urates form 
rather often occurring calculi. Urate calculi 
attain very seldom a greater diameter than 
one centimeter, and are neither very hard 
nor dense. 

Calcium Oxalate. — The crystals of calcium 
oxalate in the urine belong to two dis- 
tinct varieties. The most common and 
most characteristic shape is that of 
octahedra, with high refracting powers. 
They are soon recognized under the 
microscope, as squares or rectangles, 
colorless and with diagonal lines, the 
whole resembling an envelope. The 
second form met with are the " hour- 
glass" and "dumb-bell" crystals ; they 
are really oval-shaped bodies. 
These crystals are much smaller than uric 
acid crystals and do not dissolve in alkalies, 



SEDIMENTS IN ACID URINE. 40 

water, alcohol, ether or acetic acid, but are 
readily soluble in hydrochloric or other 
mineral acids. 




Fig. 7. — Calcium Oxalate Crystals. 

Calcium oxalate is not infrequently found 
in the deposit of urine after a vegetable 
diet, as for instance, asparagus or rhubarb. 
The oxalate of lime or " mulberry calculi " 
most always occur as large and rough con-- 
cretions, which are very hard and brittle. 
Pure calcium oxalate calculi occur often, 
but they frequently occur in combination 
with uric acid. 



SEDIMENTS IN ALKALINE URINE. 41 




Fig. 8. — Mulberry Calculus, its Section. 

Calcium Sulphate Crystals occur occasionally 
in the deposit of urine in the form of 
radiating needles, but seem to bear no 
special significance. 

Hippuric Acid. — Is excreted in large amounts 
by herbiverous animals, but occurs only 
in small amounts in human urine, and 
then especially after the prolonged use 
of certain vegetables and fruits. The 
crystals of hippuric acid occur usually 
as colorless prisms with well defined 
ends, and vary considerably in size. 

2. Sediments in Alkaline Urine. 

On standing for some hours the urine be- 
comes alkaline. This is due to the formation 
of carbonate of ammonia, and then a new class 
of urinary sediments appear, which are all 
soluble in dilute acids. 

These deposits consist to the greater part 
of the earthy phosphates — the triple phos- 
phate and the calcium phosphate. 



SEDIMENTS IN ALKALINE URINE. 42 

Triple Phosphate, or Ammonio-Magne- 
sium Phosphate, Mg NH 4 P0 4 . 6 H 2 0. 

— Occurs always in fermenting ammo- 
niacal urine, and is only of clinical 
interest when occurring in the urine at 
the instant it is voided. 
There are two principal forms of crystals 
of triple phosphate. The star-shaped, feath- 
ery variety, occurring but rarely in urine, 
and the "coffin-shaped" variety — rectangu- 
lar prisms with beveled ends, ranging in 
size from the most minute crystals to great 
transparent masses. 




Fig. 9. — Triple Phosphate Crystals. 



SEDIMENTS IN ALKALINE URINE. 



43 



Calcium Phosphate or Phosphate of Lime, 

Ca 3 (P0 4 ) 2 . — Occurs not only in alkaline, 
but also in its crystalline form, in slight- 
ly acid, to ammoniacal decomposition 
tending urines, and forms mostly amor- 
phous deposits, which may be mistaken 
by the naked eye for pus or other or- 
ganic substances. Under the micro- 
scope the amorphous sediment presents 
itself as small, colorless granules. 
The crystalline variety of phosphate of 
lime is not often met with as a deposit of 
urine. The wedge-like, prismatic crystals 




Fig. io. — Calcium Phosphate Crystals. 



SEDIMENTS IN ALKALINE URINE. 44 

vary greatly in size and shape, and often 
form stars or rosettes, the points of the 
wedges turned towards the centre. 

Urine, which is already alkaline when 
voided, throws down the triple phosphates 
at once. The ammoniacal decomposition of 
urine occurs in these cases within the organ- 
ism, in the urinary organs, and then mucus 
and pus are regularly present. 

Calcium phosphate calculi do not occur 
frequently. They may be of a dense or 
spongy structure, and appear in two forms — 
the round or oval-shaped, ranging in size 
from a bean to a hen's egg, and chalky in 
appearance and to the touch, and the irreg- 
ular shaped, which are of a more grayish 
color and of a dense structure. 

Calcium phosphate and triple phosphate 
often concrete. The concretion has been 
termed " fusible calculus," and attains often 
a large size. This calculus is rather spongy, 
of a grayish-white color, insoluble in water 
and alkalies but very soluble in mineral 
acids. They are invariably caused by am- 
moniacal urine. 

Ammonium Urate. — Occurs in sediment of 
urine associated with the phosphates, 
presenting characteristic yellow or 
brownish spheres, to which spikes or 
projections are generally attached. They 



SEDIMENTS IN ALKALINE URINE. 45 

vary greatly in shape and are often 
called "thorn apple" shaped crystals. 
The smaller ammonium urate crystals 
often occur without spikes. 




Fig. 11. — Ammonium Urate Crystals. 

Calcium Carbonate.— Occurs but rarely in 
urine. It forms little spheres, which 
evolve carbon dioxide when treated with 
acetic acid. Concretions of calcium 
carbonate are small and smooth, and 
are often of a great density. They 
occur rarely. 



SEDIMENTS IN ALKALINE URINE. 46 

Leucin and Tyrosin. — Most always occur 
together, also in urine. They are the 
final products of tryptic digestion of 
certain proteid substances, and are met 
with in the urine during the course of 
certain pathological conditions of the 
liver and in acute phosphorus poison- 
ing. 

Leucin, C 6 H 13 NO a . — Crystallizes in white, 
glistening plates and also in little clusters of 
fine needles, branching out from a centre. In 
the deposit of urine, it is often impure, and 
appears yellowish, hardly showing any 
crystalline structure and resembling minute 
drops of oil. 

Leucin has a greasy feeling but is insoluble 
in ether — the mode of differentiation from 
oil particles. It is soluble in heated alcohol 
and in alkalies. Its nature may be con- 
firmed by Scherer's test. When fused with 
nitric acid on platinum foil leucin leaves a 
colorless residue, which on being heated 
with potassium hydrate yields an oil-like 
substance not adhering to the piatinum foil. 

Tyrosin, C 9 H tl No 3 . — Crystallizes in 
sheaves of very fine, snow-white, radiating 
crystals. It dissolves with difficulty in cold 
water, dissolves readily in hot water and hot 
alcohol, in acids and alkalies. Tyrosin re- 
sponds readily to Millon's reaction. 



SEDIMENTS IN ALKALINE URINE. 47 




Fig. 12. — Leucin and Tyrosin Crystals. 

Cystin, C 3 H 7 NS0 2 . — Occurs rarely in the 

urine. It is found in two forms : t — as 

six-sided plates of "mother-of-pearl" 

appearance, and 2 — as four-sided square 

prisms, with high refractive power and 

laying singly or in star clusters. 

Cystin is insoluble in alcohol, ether, acetic 

acid, cold and hot water, and in solutions 

of ammonium carbonate, but is soluble in 

caustic alkalies and strong acids. 

Cystin crystals somewhat resemble those 
of uric acid, and may be readily distin- 
guished from the latter by different methods. 
The most simple method consists in treating 



ANATOMICAL BODIES. 

with hydrochloric 



48 
cystin 



crystals with hydrochloric acid 
crystals are dissolved while those of uric 
acid remain unaffected. 




Fig. 13. — Cystin Crystals. 

Cystin contains about 25$ of sulphur and 
differs on this account from most organic 
substances of the body. Cystin concretions 
do not occur frequently in the bladder. 
They are mostly of a round or cylindrical 
form, medium-sized and compressible. 

b. A?iatomical Bodies. 
The anatomical bodies in urinary sediments 

may consist of, or contain : 

Blood, Pus, Epithelial Cells, Casts, Fungi 

and Bacteria, and Spermatozoa. 



ANATOMICAL BODIES. 49 

Blood. — As a sediment in urine may come 
from any part of the genito-urinary tract. 
In haemorrhages from the kid?wy, the 
urine usually presents a reddish-brown 
color, a lowered specific gravity, an acid 
reaction, and contains renal epithelium 
and casts. Haematuria may be caused 
by the so-called Bright's disease, by 
amyloid and tubercular renal disease, 
by malignant growths of the kidney, 
by renal calculus, -abscess, -embolism, 
-cysts, etc., by the action of certain drugs, 
as cantharidis, etc., and as a result of 
injuries to the kidneys. 
In haematuria of vesical origin the urine 
is very often alkaline in reaction, especially 
so if chronic cystitis be present. Triple 
phosphates, mucus and pus are usually in 
the train of vesical haematuria. The blood 
is brighter than in haematuria of renal 
origin. The causes of vesical haematuria 
are principally : stone in the bladder, cys- 
titis, carcinoma, neoplasms, etc. 

Haematuria of urethral origin may be 
diagnosed by the haemorrhage occurring be- 
fore the urine is voided. It is caused by 
acute urethritis, blenorrhcea, chancre or 
cutting of strictures. The microscopical 
characteristics of blood corpuscles are so 
well known, that I refrain from giving them 
here again. In urine, though, after they 



ANATOMICAL BODIES. 



50 




Fig. 14. — Human Blood Corpuscles. 

have soaked for any length of time, espe- 
cially if a decomposition takes place, they 
lose their sharp, clear, round outline, and 
become rather shapeless and. more or less 
granular, so that they may be mistaken for 
pus corpuscles. They may, however, be 
distinguished from the latter by the absence 
of visible nuclei. 



Pus. — As a sediment in urine may be caused 
by inflammatory processes of any part 
of the urinary tract. When the pus 
cells are derived from the kidney they 
indicate a suppurative inflammation of 



ANATOMICAL BODIES. 5 1 

that organ and are usually accompanied 
with considerable amount of albumin 
and with pus casts. The urine in these 
cases generally retains its acidity. 
When the pus cells are of vesical origin 
the urine is often ammoniacal when 
passed, or it very soon turns alkaline 
upon standing. In these cases the urine 
contains large quantities of mucus and 
its deposit is of a more syrup-like con- 
sistency and tenacity than when the 
pus corpuscles are derived from the 
kidney. Amorphous and triple phos- 
phates and excess of bladder epithelium 
are usually accompanying pus cells 
derived from the bladder. Pus derived 
from affections of the prostate often 
appears in the form of threads, and pus 
corpuscles caused by urethritis are very 
similar, appearing as little string-like 
threads. 
Pus cells present under the microscope a 
circular, quite colorless, granular disc-like 
appearance, and are larger than the blood 
corpuscles. They show distinct nuclei, 
which are often multiple. 

When pus cells are treated with some 
acetic acid they lose their granular appear- 
ance, swell up, become more colorless, and 
their nuclei become even more visible. Hy- 
drate of potassium and other caustic alka- 



ANATOMICAL BODIES. 52 

lies convert the pus corpuscles into a gelati- 
nous substance. (See Donnes's test for 
pus.) 

Pus cells which remain for some time in 
alkaline urine may be similarly converted. 




Fig. 15. — Pus Corpuscles. 

Epithelium. — Epithelial cells from some part 
of the urinary apparatus are to be met 
with in small quantities in every urine. 
In pathological conditions of the urin- 
ary organs, however, the epithelium is 
often thrown off in considerable quan- 
tities. 
The various cells are by no means char- 
acteristic — as claimed by many observers — 



ANATOMICAL BODIES. 



53 



for certain locations or lesions of the urin- 
ary tract. The epithelial cells are masses 
of protoplasm with single nuclei, and are 
most always granular in structure. They 
occur as a urinary deposit in three varieties. 
a. Round Epithelial Cells are small and 
round, and show nuclei. They resemble 
pus cells but are somewhat larger and have 
a more visible, single nucleus. The round 
cells may originate from any part of the 
urinary tract, but if they predominate in a 
urine in which also albumin is contained, it 
may be concluded that they are of renal 
origin. 




Fig. 16. — Epithelium, as found in Urinary Deposit. 



ANATOMICAL BODIES. 54 

b. Columnar Cells are of various shapes and 
sizes, but are always elongated and have a 
distinct nucleus. They generally are thrown 
off in the small passages of the urinary 
apparatus, and it is claimed that they never 
originate in the kidney itself. 

c. Squa?nous Cells, or "pavement" epithe- 
lial cells, are large and flat and have a dis- 
tinct nucleus. They are usually derived 
from the bladder or the vagina. Those 
coming from the latter are most always the 
larger and occur often in sheets, whereby 
the cells overlay each other like the tiles 
on a roof. 

Casts. — Urinary casts are of the utmost clin- 
ical importance, and when closely 
studied are a positive aid in diagnosis 
of renal disease and of its course. It 
seems to be generally agreed upon, that 
the material which forms the basis of 
the casts is a proteid substance, not 
kindred, however, to any proteids with 
which we are acquainted, and that they 
are formed of coagulated blood pro- 
teids, which pass into the tubules, thus 
rendering the urine albuminous. In 
addition thereto the urine may contain 
little plugs of already coagulated pro- 
teid matter. This coagulation occurs 
as the proteid substances are traveling 



ANATOMICAL BODIES. 55 

along the tubules, which maybe plugged 

up by the coagula to such an extent, 

that they cannot transmit any urine. 

Finally, however, these clots are driven 

out of the tubules by the pressure of 

the urine — these clots are what we 

designate as casts. 

The casts formed in this manner are 

diminutive, cylindrical masses with parallel 

sides. One end of the cast is generally 

rounded off — the result of the rolling around 

of the soft and tough material of which it 

is composed. 

There are three classes of renal casts : 

1. Those composed of morphological 
substances, as epithelium, blood- and pus- 
corpuscles. 

2. Those composed of broken-down mor- 
phological substances, as seen in the granu- 
lar casts and fatty casts. 

3. Those clear casts, generally termed 
" hyaline." 

Epithelial Casts are generally : medium 
sized, and are soon discovered under the 
microscope. Their presence in the urine is 
a conclusive sign of inflammation in those 
parts, from whence they derive. The cells ap- 
pear swollen and granular and may occur in 
rows or patches over the surfaces of the casts. 

Blood Casts do not occur frequently in the 
urine, and are generally difficult to find. 



ANATOMICAL BODIES. 56 

Pus Casts are also of rare occurrence, but 
pus cells are sometimes found on the sur- 
face of granular casts. 

Granular Casts occur in the urine in 
different variations, as highly granular, 
finely granular, coarsely granular, light and 
dark granular, etc., and differ consequently 
in size, shape and appearance. They are 
white, gray, yellowish and brown, and con- 
tain often on their surfaces epithelial cells, 
fat globules and leucocytes. 




Fig. 17. — Epithelial Casts. 

Hyaline Casts are rather colorless and 

transparent, and w T hen more opaque are 

called waxy casts. They are generally of 

considerable length and often difficult to 



ANATOMICAL BODIES. 57 

detect. The so-called narrow hyaline casts 
are exceedingly transparent and non-refract- 
ing, while the broad hyaline casts reflect 
better and are more distinct in structure. 

Fatty Casts are those where minute, shiny 
globules of fat, either unbound or in epi- 
thelial cells, are impacted in granular or 
hyaline casts. 

Casts are hardly heavier than water, and 
settle very slowly in the urine. Generally 
an antiseptic is added to this, and about 18 
hours are allowed for the precipitation. 
The modern centrifugal method perfects 
sedimentation in a few minutes. 




Fig. 18. — Granular Casts. 



ANATOMICAL BODIES. 58 




Fig. 20. — Fatty Casts. 



ANATOMICAL BODIES. 59 

Fungi. — Upon standing at an ordinary tem- 
perature for some time, normal urine be- 
comes filled with micro-organisms. Abnor- 
mal urine, when just voided, contains 
already, in most cases, micro-organisms. 
In decomposing urine we find examples of 
the three classes of fungi — molds, yeast 
plants and bacteria. 

Molds occur quite rarely and may ap- 
pear after the urine has been exposed to the 
air for some time, but not when glucose is 
present, in which instance they will make 
their appearance in large quantities just 
after the alcoholic fermentation. 

Yeast Plants occur in small quantities in 
nearly every specimen of decomposing urine. 
They consist of round or oval-shaped cells 
with a nucleus. These cells are generally 
arranged in bead-like forms, with additional 
cells or buds occasionally attached thereon. 
In diabetic urine the yeast fungi develop 
very rapidly and in great abundancy. 
Bacteria. — Are present in all decomposing 

urines. The micro- 
coccus urese is an 
organism of com- 
paratively large 
size and occurs 
mostly in chain- 
like strings, but 
Fig. 21.— Yeast Fungi in Urine, also as single 




ANATOMICAL BODIES. 60 

round bodies. The urine may also con- 
tain a great variety of other micro- 
organisms. 
Pathogenic Bacteria, so called, are said to 
occur in the urine in two varieties, as micro- 
cocci and bacilli. A number 
of micrococci and bacilli cer- 
tainly do occur in the urine. 
In the estimation of the writer, 
however, they are neither 
pathogenic nor does their 
presence aid and establish a 
trustworthy or rational urin- 
ary diagnosis. 

Spermatozoa. — Are found not 
infrequently in normal 
and abnormal urine. They 
are very minute thread-like bodies with 
a head shaped like a pear, and with a 
long, slender, tapering, tail-like extrem- 
ity. In urine spermatozoa are most 
always in the quiescent state, and they 
retain their typical form even after the 
urine has stood for a number of days. 




Fig. 22. 

Micrococcus 

Ure^;. 



ANATOMICAL BODIES. 



6j 




Fig. 23. — Spermatozoa in Sediment of Urine. 



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